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Person-Centered Medical Home Plus (PCMH+)

Overview

Person-Centered Medical Home Plus or PCMH+ provides person-centered, comprehensive and coordinated care to HUSKY members. PCMH+ builds on the success of Connecticut Medicaid's Person-Centered Medical Home (PCMH) program which works to improve the quality of care our members receive. The PCMH+ program works to improve HUSKY member's overall health and assists with access to services like access to healthy food, transportation to appointments and assistance in finding community agencies that support housing or employment. Learn more about PCMH+ with the Member Information Guide.

The Department is extremely proud to continue to partner with the current Participating Entities (Legacy PEs), and also New PEs that are being selected through RFP, in Wave 2. Wave 1 of PCMH+ has evidenced the great value of building upon initial primary care practice transformation work with renewed attention to engagement with members, a broader array of care coordination strategies, opportunities for expansion of care teams to include community health workers, connections with community-based organizations and also robust provider collaborative activities. These efforts have demonstrably contributed to the health, well-being and care experience of the HUSKY Health members who are involved. The Department’s approach with Wave 2 is as follows:

Wave 2 contracts are effective from April 1, 2018 (for Legacy PEs) and May 1, 2018 (for New PEs), through December 31, 2019 (with a separate performance year for each of calendar years 2018 and 2019).

Legacy PEs that continue to meet all PE requirements and execute contracts with the Department will roll forward into Wave 2.

New PEs are being selected through the Wave 2 RFP. We will broadcast the results of the RFP as soon as is possible.

January 9, 2017 - Request for Proposals (RFP) for PCMH+ Wave 2

The Department of Social Services requests proposals for PCMH+ Wave 2.

PCMH+ Wave 2 aims to continue to improve health outcomes and the care experience of Medicaid members and to contain the growth of health care costs. Selected FQHCs and Advanced Networks will provide care coordination to improve the quality, efficiency, and effectiveness of care delivered to Medicaid members. If a PCMH+ Participating Entity meets specified quality standards and generates savings for Medicaid, that entity will receive a shared savings payment. FQHC Participating Entities will also receive a monthly Care Coordination Add-On Payment.

IMPORTANT NOTE: All Participating Entities (both Advanced Networks and FQHCs) that participated in PCMH+ Program, Wave 1, will be rolled over into participation in the PCMH+ Wave 2, for a project period beginning April 1, 2018 and running through December 31, 2019, without being required to respond to this RFP, so long as they comply with all applicable requirements of PCMH+ Wave 2, comply with all requirements contained within the RFP, and have notified the Department of their intent to participate in PCMH+ Wave 2 in accordance with the terms of the amendment to their contract for PCMH+ Wave 1.

December 19, 2017 - Update on PCMH+ Wave 2

The Department of Social Services (DSS) remains strongly committed to the success of the Person-Centered Medical Home Plus (PCMH+) program.

In support of that commitment, Participating Entities (PEs) currently participating in PCMH+ Wave 1 will be offered a three-month extension to their current contract, which will run until March 31, 2018. Per member per month (PMPM) payments to Wave 1 FQHCs will continue from January to March using the current Wave 1 member assignment.

The Wave 2 RFP will maintain the requirement that applicants serve a minimum of 2,500 attributed PCMH+ eligible members and will maintain the $4.50 PMPM payment to all current FQHCs and any new FQHCs selected through the procurement process. Due to state budget constraints, PMPM payments will remain limited to FQHCs. However, both current and new Advanced Networks may apply for grant funding through the State Innovation Model (SIM) transformation awards.

To remain consistent with national quality measure results and facilitate comparisons for shared savings calculations, the following timeline applies for PCMH+ Wave 2:

Quality measures and all other measures used in the shared savings calculation will be based on the full calendar year 2018 (January 1, 2018 - December 31, 2018).

PCMH+ Wave 2 start date is April 1, 2018.

Wave 2 PCMH+ member assignment lists will be distributed on or about April 1, 2018 (based on an attribution from March 2018).

Wave 2 PMPM payments to FQHCs will begin for the month of April 2018 using the attribution analyzed from March 2018.

Those PEs currently participating in PCMH+ Wave 1, that are in good standing, will NOT be required to submit a response to the Wave 2 RFP and will be automatically offered the right to enter into a contract amendment to be designated as a PE for PCMH+ Wave 2. Such offer is wholly contingent upon the PEs agreement to comply with all of the requirements for PCMH+ Wave 2.

August 8, 2017 - PCMH+ Wave 1 Contracts to be Extended

On August 8th, 2017, the Department of Social Services sent this notice to the PCMH+ Participating Entities:

The Department of Social Services remains strongly committed to the success of the PCMH+ initiative. Given the current uncertainty around the General Assembly's adoption of a state budget for the biennium, however, the Department has determined that it is necessary to revisit and revise its original procurement plans for PCMH+ Wave 2. A state budget is needed before the Department can properly plan for, and release, a Request for Proposals for PCMH+ Wave 2. For that reason, the Department will be extending Wave 1 contracts with its current PCMH+ Participating Entities for three months, through March 31, 2018.